Hypochromic Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Hypochromic and links to relevant pages within the course.
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| Wright's stained peripheral blood smear made from EDTA specimen.What RBC morphologies are present? | View Page |
| CBC Results WBC 6.1 X 10 9/L (Reference range 4.0 - 10.5 X 109/LRBC 4.84 X 1012/L (Reference range 3.50 - 5.50 X 1012/LHb 8.4 g/dL (Reference range 12.0 - 16.0 g/dL)Hct 28.8 % (Reference range 36.0 - 48.0%)MCV 59 fL (Reference range 80.0 - 100.0 fL)MCH 17.4 pg (Reference range 26.0 - 34.0 pg)MCHC 29.3 g/dL (Reference range 32.0 - 36.0 g/dL)RDW 19.5 % (Reference range 11.0 - 15.0 %)Plat 591 X 109/L (Reference range 150 - 400 X 109/L)Even though the RBC count is normal, it is increased for the amount of hemoglobin present. The concentration of hemoglobin in the RBCs is slightly decreased (hypochromic) and the cells are small (microcytic). The variation in RBC size is also slightly increased as are the platelets. | View Page |
| What is the classification of this patient's anemia, based on the CBC results? | View Page |
| Summary The normal RBC count (4.84 x 1012/L) in this case, together with the decreased hemoglobin (8.4 g/dL) and MCV (59 fl) is an indicator of ineffective erythropoeisis that often points to thalassemia.The RBC morphology shows slight hypochromic microcytosis with codocytes, schizocytes, and basophilic stippling. Schizocytes form by several mechanisms, one being the removal of RBC inclusions.This patient's elevated bilirubin correlates with her presentation of sclera icterus; her splenomegaly is consistent with increased RBC destruction.The Hb electrophoresis demonstrated a normal pattern, initially, but the unstable Hemoglobin H was revealed upon repeat electrophoresis with reduced incubation time. Hemoglobin H is the result of beta globin chain tetramer formation due to the insufficient supply of alpha globin chains in alpha thalassemia intermedia.People with Hemoglobin H disease (alpha thalassemia intermedia) usually have a normal life expectancy without treatment. However, hemolysis may lead to moderate anemia that may be treated with splenectomy. | View Page |
| Alpha Thalassemia Major Anemia is fatal.Red blood cell (RBC) count is increased.Hemoglobin (Hb) is severely decreased.Mean corpuscular volume (MCV) is decreased. Mean corpuscular hemoglobin concentration (MCHC) is decreased.Red cell distribution width (RDW) is increased.RBC morphology shows slight hypochromic microcytosis with codocytes, schizocytes, nucleated RBCs.Reticulocytes are increased.Hb electrophoresis demonstrates abnormal pattern on cord blood: Hb A - absentHb Bart's - 80-90%Hb Portland - 0-20%Bone marrow demonstrates marked erythroid hyperplasia. | View Page |
| Alpha Thalassemia Intermedia Anemia is moderate.RBC count is increased.Hb is moderately decreased.MCV is decreased. MCHC is decreased.RDW is increased.RBC morphology shows slight hypochromic microcytosis with codocytes, schizocytes, and basophilic stippling.Reticulocytes are moderately increased.Hb electrophoresis demonstrates abnormal patterns in both adults and neonates.Adults:HbA decreasedHbA2 decreasedHbF normal to decreasedHb H -2-40% (beta chain tetramers)Neonates: 10-40% Bart's (gamma chain tetramers)Hb H inclusions are frequently seen.Bone marrow demonstrates erythroid hyperplasia. | View Page |
| Alpha Thalassemia Minor Anemia is mild to absent.RBC count is increased.Hb is slightly decreased.MCV is decreased. MCHC is slightly decreased.RDW is normal to slightly increased.Red Blood Cell morphology shows slight hypochromic microcytosis.Reticulocytes are normal to slightly increased.Hb electrophoresis demonstrates a normal pattern in adults:Hb A - 97-98% Hb A2 - 1-2.5% Hb F - <1%. Neonates have 5-15% Bart's Hemoglobin (gamma chain tetramers).Hb H inclusions are rarely seen.Bone marrow demonstrates erythroid hyperplasia. | View Page |
| Laboratory Test Results Test Patient Result Reference Intervals (Adult female) White blood cell (WBC) count 3.7 x 109/L 4.4 - 11.3 x 109/L Red blood cell (RBC) count 5.6 x 1012/L 4.1 - 5.1 x 1012/L Hemoglobin (Hb) 10.5 g/dL 12.3 - 15.3 g/dL Hematocrit (HCT) 36.6% 35.9 - 44.6% MCV 65.8 fL 80.0 - 96.0 fL MCH 19.9 pg 27.5 - 33.2 pg MCHC 26.7% 33.4 - 35.5% RDW 14.0 <14.5 Platelets 249.0 x 109/L 100.0 - 450.0 x 109/L Total serum iron 165 µg/dL 60 - 150 µg/dL Iron-binding capacity 230 µg/dL 250 - 400 µg/dL The RBC count is increased for the amount of hemoglobin present. The concentration of hemoglobin in the RBCs is slightly decreased (hypochromic) and the cells are small (microcytic). The variation in RBC size (RDW) is within normal limits. | View Page |
| Why is it important to note that the red cell distribution width (RDW) in this case is normal ? | View Page |
| Case History Summary The laboratory findings in this case represent classic findings seen in beta thalassemia minor including: erythrocytosis, decreased hemoglobin, normal hematocrit, normal RDW, and the presence of codocytes (target cells). This patient does have a mild anemia, but some patients with beta thalassemia minor have no anemia. Hemoglobin electrophoresis confirms this diagnosis, showing an increased Hb A2 level and decreased Hb A.In addition, the slightly increased iron and slightly decreased TIBC contradict a suspicion of iron deficiency. These chemistry results are typical for beta thalassemia, even though the red blood cells are microcytic and hypochromic. | View Page |
| The abnormal RBCs seen in this illustration are indicative of: | View Page |
| The RBCs seen in this illustration are indicative of: | View Page |
| Which of the following would not be represented in the usual classification of anemia: | View Page |
| The condition most likely associated with the peripheral blood picture shown in the photograph is: | View Page |
| The condition most likely associated with the peripheral blood picture in the photograph is: | View Page |
| Cells as shown in this iron-stained bone marrow preparation are found in each of the following conditions except: | View Page |
| Iron Deficiency Absorption of iron is interrupted in the absence of the stomach. Microcytic, hypochromic red cells are not conspicuous in the previous slides to reflect this deficiency. However, multiple factors influencing red cell morphology are so diverse in this case and therapy so uncontrolled that iron deficiency is not perfectly expressed morphologically. | View Page |
| The cells that are indicated by the arrows are examples of what type of red blood cell? | View Page |
| Most of the red blood cells in this field could be described as: | View Page |
| Using the lymphocyte as a guideline, the cells that are indicated by the arrows would be described as what type of cells? | View Page |
| Which of the following terms best describes the cells in this field? | View Page |
| Which of the following terms best describes most of the cells in this field? | View Page |
| More Hypochromic Cells Another field showing hypochromic cells. | View Page |
| All of the following statements are true of hypochromic red cells EXCEPT: | View Page |
| Hypochromia Examples of hypochromic cells are seen in this slide. Notice the thin rim of hemoglobin and the large area of central pallor present in most of these cells. Hypochromic cells are cells which are unusually thin, or in which the hemoglobin concentration is decreased. Decreased hemoglobin concentration can be caused by decreased amounts of iron available for hemoglobin production. The MCHC for this patient was significantly decreased (26 gm/dl of RBCs) indicating a severe degree of hypochromia. When hypochromia is less severe, not all cells will be affected; thus some cells may appear almost normal whereas others show hypochromia. | View Page |
| What type of cells are present in this slide? | View Page |
| What type of cells are indicated by the arrows in this slide? | View Page |
| What type of cells are present in this slide? | View Page |
| In this slide, what type of cells are present? | View Page |